I denna rapport presenteras resultat från två enkäter som skickades till läkare verksamma inom psykiatrin i Stockholms län år 2018 respektive år 2020. Enkäterna innehöll frågor om läkares arbete med sjukskrivningar. Syftet var att få kunskap om läkares erfarenheter av arbete med sjukskrivning av patienter inom psykiatrin och om detta förändrades när den nya funktionen rehabiliteringskoordination(1-3) infördes vid psykiatriska enheter. Enkäterna baserades på enkäter använda i tidigare studier(4, 5).

Background

Mental illness is an increasing health problem globally. However, many individuals do not seek health care although evidence-based care is available. Research has shown that self efficacy is associated with various health outcomes and it is of importance to investigate if it also is associated mental illness. Early detection promotes recovery and decreases suicide risk.

Aim

The aim of this study is to investigate whether low levels of self efficacy is associated with a higher degree of mental illness and whether level of self-efficacy influence health seeking behaviour.

Methods

This is a cross-sectional study based on data from the Health Assets study, with data collected in 2008 in West Sweden. The study population is a randomly selected population sample of 4027 individuals, aged 18–65 years. Data collection was done by a postal questionnaire and the response rate was 50.4%. Bi-and multivariate analyses were employed to investigate associations and results were stratified on sex, age, civil status, education and social support.

Results

A total number of 1361 (36%) out of 3811 individuals answered ‘Yes’ on the question ‘Have you ever felt so mentally ill that you had (felt a need) to seek care’. A total of 33% of the women answering yes were found in the lowest quartile of the general self efficacy scale, 20% in the highest quartile. Corresponding figures for men were 30 and 23% respectively. The most common reason stated for not seeking health care was a belief that the mental health problem would disappear by itself. Others reasons mentioned were beliefs that health care would not help, they did not know were to go or they felt ashamed for showing others they suffered from mental illness.

Conclusion

Mental illness is a serious health problem and access to care needs to be improved. Health promotion should also include individual traits/characteristics such as self efficacy and health-seeking behaviour.

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidencerates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data ondisability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with apsychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensionswith psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings. © 2006 IOS Press. All rights reserved.

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18–40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview (DSM-IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men (OR 1.94, CI 1.11–3.42) and those supported by social grants (OR 2.28, CI 1.06–4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single (OR 2.35, CI 1.20–4.62), had no education (OR 3.41, CI 1.04–11.21), had a low income (OR 3.26, CI 1.55–6.80) and had no social support from friends when ill presented higher odd ratios (OR 1.73, CI 1.07–2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness. © 2017 John Wiley & Sons Ltd

In countries with highly decentralized welfare services, disparities between municipalities and regions can be expected. The article analyzes whether, and in that case, how, the type of post-school occupation among graduates from Swedish upper secondary school for pupils with intellectual disability (USSID) varies depending on the municipality or geographic region the former pupils live in. The analyses are based on data from a unique national database that includes 12,269 pupils who graduated from USSID between 2001 and 2011. Results show that municipality of residence has an independent effect on the type of post-USSID occupation. Moreover, the total percentages of relocations in the studied population are low.

The authors conclude that the geographical variations identified in other parts of the Swedish welfare system also apply partly to post-USSID occupations. The article discusses whether municipal and regional affiliation is of particular significance for pupils from USSID, because of their low propensity to relocate.

Aim: This study explores and analyses, from an intersectional perspective, the association between parents’ country of birth as well as their level of education and their children's type of occupation after graduating from Swedish upper secondary school for pupils with intellectual disabilities (ID).

Method: This is a quantitative study based on three registers (HURPID, LSS, LISA). The analyses are based on logistic regression, interaction analysis and chi-square tests. The sample size was 12,269.

Results: Children of less-educated parents tend to have paid employment and children of highly educated parents tend to participate in disability day programs. Parents’ country of birth and level of education affect the former pupils’ post-school occupation in different ways. The association between parents’ country of birth and former pupils’ occupation is modified by parents’ level of education.

Conclusions: Knowledge and awareness of different background conditions among children graduating from upper secondary school for pupils with ID need to increase.

Studien analyserar sambanden mellan sysselsättning för unga vuxna med intellektuell funktionsnedsättning som gått i gymnasiesärskolan och deras sociala bakgrund, mätt som föräldrarnas utbildningsnivå och geografiska härkomst. Den här registerstudien baseras på Halmstad university register on pupils with intellectual disabilities (HURPID), Longitudinell integrationsdatabas för arbetsmarknads- och sjukförsäkringsstudier (LISA) samt LSS-registret. Studien omfattar 12 269 unga med intellektuell funktionsnedsättning som gick ut gymnasiesärskolan mellan 2001 och 2011. De samband som studeras analyseras genom multipla logistiska regressioner. Resultaten visar att föräldrars utbildningsnivå har viss betydelse för före detta gymnasiesärskoleelevers sysselsättning. Barn till högutbildade föräldrar har med större sannolikhet en sysselsättning inom daglig verksamhet och barn till lågutbildade föräldrar har med större sannolikhet ett förvärvsarbete. Sannolikheten för att ha någon av sysselsättningskategorierna daglig verksamhet eller förvärvsarbete är lägst bland barn till föräldrar som är födda i länder utanför Norden. Högutbildade föräldrar antas ha en högre grad av den ”välfärdskompetens” som krävs för att hantera dagens välfärdssystem och härigenom kunna påverka de ungas möjligheter att få insatser likt daglig verksamhet. Lågutbildade föräldrar antas ha egna erfarenheter av, och kontakter med, arbetsplatser där det finns arbetsuppgifter utan (eller med låga) formella kompetenskrav. Samhällets kunskaper och medvetenhet om den sociala bakgrundens betydelse för efter(sär)gymnasial sysselsättning bland unga med intellektuell funktionsnedsättning behöver öka. Detta i syfte att bättre möta varierande individuella förutsättningar och främja etablering i arbetslivet för fler unga vuxna med intellektuell funktionsnedsättning vid övergången från skoltid till arbetsliv.

Knowledge about people with intellectual disability (ID) and their connections to the labor market is scarce. The aim of this study was to describe and analyze the entry into and representation in the Swedish labor market for people with ID, discussed with a special focus on the gender perspective. This study included 2,745 individuals (30% women and 70% men) who graduated from Swedish upper secondary schools for pupils with intellectual disability (USSID) in the 2000s, and who were defined as employees in 2011. Graduation data from 2001 to 2011 were analyzed in relation to employment data from 2011 and adjusted for gender, graduation year, and educational program. Results show that men who attended a national USSID program and graduated between 2001 and 2006 were the most likely group to have a job. The authors conclude that the gender differences in the Swedish labor market are more clearly pronounced among women and men with ID in relation to employment rate, wage levels, and professions than in the general population. Education, welfare-services, and interventions specifically targeted to meet the needs of people with ID have to develop in more gender-sensitive ways. © 2016 International Association for the Scientific Study of Intellectual and Developmental Disabilities and Wiley Periodicals, Inc.

Objective: To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers’ work- and knowledge-related characteristics and attitude to CMDs.

Methods: Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics.

Results: Few managers found out about CMDs themselves; another source was more common e.g., employees’ self-disclosure. Managers’ overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established.

Conclusion: Managers’ awareness about employees’ CMDs mainly came about through employees’ self-disclosure. Managers’ attitudes and work conditions were related to the way of finding out.

Copyright © 2021 by the American College of Occupational and Environmental Medicine.

Objectives: The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period. Methods: We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register. Results: Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women. Conclusions: High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile. © 2012 Springer-Verlag.

Several studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension. However, the issue of a possible gender-based pattern in this context has received little attention. The aim of the present study was to assess the impact of different sleeping problems and sleep duration on the rate of disability pension during a 12-year follow-up period.

The cohort was recruited by random invitations from the general population of Malmö, Sweden, aged 45–65 years in 1992; the participation rate was 41% (n=14,555). The participants in this study were the 2,254 men and 2,065 women who were healthy and working at least 30 hours per week at baseline. Baseline data included socio-demographic factors, lifestyle, body mass index, the Job Content Questionnaire, social support and participation, ‘stress outside work’, self-rated health and an instrument assessing sleep quality and duration. Information on disability pension was obtained through record linkage from the National Health Insurance Register.

Disability pensions were granted to 9% of the men and 15% of the women during the follow-up period. Affirming moderate or very large problems with any of ‘initiating sleep’, ‘waking up during the night’, ‘waking up too early’, and ‘not feeling rested by sleep’ was defined as ‘problems with sleep’, and this was present in 33% of the women and 41% of the men. The age-adjusted hazard ratios for problems with sleep and subsequent disability pension were in men 1.8 (95% CI 1.4 to 2.4) and in women 1.6 (95% CI 1.3 to 2.0). In the full model, after adjustment for sleep duration and for potential confounders and/or mediators, these HRs decreased to 1.4 (95% CI 1.1 to 2.0) in men and 1.4 (95% CI 1.1 to 1.7) in women.

Short sleep duration, i.e. ≤6 hours/night on weekdays, was associated with having problems with sleep, long sleep duration was not. Only two percent of the population slept ≥9 hours/night. In women, but not in men, long sleep duration was strongly associated with the subsequent granting of a disability pension; the HR was 2.8 (1.7 to 4.6). In conclusion, sleeping problems seem to be a significant risk-factor for disability pension in the middle-aged working population. There were also clear gender differences in the pattern regarding which type of sleeping problems that were most linked to disability pension.

Background

In Sweden, large variations were identified in sick-leave duration also in episodes with the same diagnoses. A decision support was developed to ensure more uniform assessment of sick leave. The present qualitative study aimed at examining the process of construction and development of the new decision support.

Methods

Qualitative analyses of data from interviews and documents were performed. Participants (n = 15) in in-depth interviews were medical and insurance experts from the Social Insurance Agency involved in the development of the decision-support. Interviews with the medical experts focused on how well their specific medical field of expertise fitted the format suggested for the decision support and how a ‘‘standard patient’’ looked like in their clinical everyday work. For both groups of interviewees, issues regarding assessment of work capacity were discussed. The documentary analysis was done reading investigations, memos, reports and minutes. Themes identified in the interviews were compared with the overall documentary analysis and constituted the basis for an epistemic analysis.

Results

The analyses showed that the decision-support was developed under a tight schedule and with strict templates for its format. The decision support was built around diagnostic categories and a majority of the experts that were used were specialized in medicine. A difficulty in the process was according to participants to produce standardised medical assessments of how a particular illness was expected to affect patients’ work capacity rather than how the illness affected the patient. The evidential basis for such assessments was scant. Findings show that conditions that were not somatic or could not be ‘measured objectively’ proved extra problematic, since much of the assessment in these situations hinges on physicians’ experience-based expertise combined with their understanding of the circumstances of individual patients.

Conclusion

The analysis indicates that ‘work capacity’ does not fall squarely within the remit of medical expertise, but is an example of ‘post-normal science’ that requires a broad range of experts from different fields both inside and outside of science coming together to pool their knowledge and build new expertise.

Objective: The aim of this study was to analyze the association between frequent headache and self-reported mental and physical work ability in a general population sample in Sweden. Methods: The study was conducted in western Sweden in 2008. Frequent headache was analyzed in relation to mental and physical work ability. Covariates included demographics and socioeconomic variables, work-related variables, and a symptom index. Self-reported and register-based sickness absence data were also analyzed. Results: Sixteen per cent of those who answered the question about headache (n = 2590) had frequent headache (at least once a week). Regression analyses showed that frequent headache sufferers were twice more likely to have poor mental and physical work ability than those having infrequent headache. Conclusions: Frequent headache was associated with poor mental and physical work ability but not with sickness absence. Copyright © 2014 by American College of Occupational and Environmental.

Changes in the welfare systems including the sickness insurance scheme are ongoing in several countries, and better knowledge on the extent of health problems in sickness absence seems needed. The overall aim of this cross sectional study was to assess and compare self-rated health, common symptoms and mental well-being in two samples of incident sick-leave cases with the general population. The study was performed in Sweden, 2008, and three samples of individuals aged 19–64 years were selected. The final study populations consisted of 3310 consecutive new employer reported sick-leave cases, 498 consecutive new self-reported sick-leave cases and 4027 individuals from a random general population sample. A mailed questionnaire was distributed. Validated questions and instruments on health and demographic data was analysed in bivariate and multivariate analyses. Poor self-rated health, high levels of symptoms and low mental well-being was reported by a significantly higher proportion in the two sick-leave samples compared with the general population. In logistic regressions with the generalpopulation as reference we adjusted for age, income, occupational class and current sick-leave. The fully adjusted OR for poor self-rated health, high levels of symptoms and low mental well-being respectively were 1.54 (95% confidence intervals 1.24–1.91), 1.95 (1.54–2.48) and 1.41 (1.11–1.79) among the employer reported male sick-leave cases and 1.94 (1.34–2.82), 1.76 (1.14–2.70) and 2.11 (1.40–3.17) among self reported male sick-leave cases. Corresponding figures for women were 1.80 (1.56–2.08), 1.42 (1.22–1.66) and 1.21 (1.03–1.43) and 2.10 (1.60–2.75), 1.97 (1.1–2.57) and 1.78 (1.35–2.36). Differences in health problems between the groups remained significant in the fully adjusted model. We conclude that sick-listed individuals have a higher burden of illness also after control for current sick leave than the general population. Consequence analyses of more rigorous legislation and increased demands need to take this into account.

Uneven division of domestic factors may contribute to sex differences in sickness absence with psychiatric disorders. The aim of this scoping review was to compile current Nordic research on domestic factors and sickness absence with psychiatric disorders. A systematic search was performed to identify studies from the Nordic countries published between 1 January 2010 and 31 December 2019. Twelve studies were included. Marital status, family situation, work-home interference (in both directions), social affiliation, and loss of child/young adult (suicide, accident, or natural death) were identified as measures of domestic factors. In 8 of the 12 studies, domestic factors were used as co-variates, while four used them as the main exposure. Social affiliation, home-to-work conflict, and total workload were not associated with the outcome. One study found that parents with children older than two years, widows/widowers, and those divorced or unmarried had an increased risk of sickness absence with psychiatric disorders. One study found that work-to-home conflict was associated with sickness absence with stress-related diagnoses in men, and with other mental disorders in women. Finally, one study found that losing a son or daughter aged 16–24 years increased the risk of future sickness absence with a psychiatric disorder regardless of the cause of death. Future studies need to develop concepts, study designs, and measurements to move this research area further. In particular, the concept of “unpaid domestic work” needs theoretical and empirical development. © 2023 by the authors

Objective: To investigate the association between managers' attitudes towards subordinates with common mental disorders (CMD), self-confidence in supporting these subordinates and managerial preventive actions (MPAs).

Methods: A cross-sectional study was conducted among Swedish managers (n = 2988) and two types of MPAs: reviewing assignments and work situation (MPA-review); talking about CMD at the workplace (MPA-talk). Binary logistic regression models were applied and adjusted for individual and organizational covariates.

Results: Managers with negative attitudes towards subordinates with CMD were less likely to have done both MPAs. Managers with higher self-confidence in supporting these subordinates were more likely to have done both MPAs compared with managers with lower self-confidence.

Conclusions: Managerial negative attitudes towards CMD and self-confidence in supporting subordinates with CMD have a role in MPAs and should be addressed in manager training programmes to encourage preventive actions. Copyright © 2023 American College of Occupational and Environmental Medicine.

Background: Common mental disorders (CMDs) are an extensive problem in the society and attributed to stigma. Prevention of CMD at work is advocated but few studies have investigated what kind of preventive actions managers take. We investigated managers’ attitudes to depression and two managerial preventive actions (MPA): ‘reviewing assignments and the work situation’ (MPA-review) and ‘taking initiative to talk about depression and anxiety at the workplace’ (MPA-talk). We hypothesized that managers’ negative attitudes towards depression would be negatively associated with both MPAs.

Methods: An on-line survey was sent in 2017 to 4737 managers, answer rate 71% (n = 3358), of which 2 899 were included in this study. Negative attitudes were measured through the 12-item instrument “Managerial stigma towards employee depression” (scores 12-72), a cut-off at the 3rd quartile was used as an indicator for having negative attitudes. MPAs were measured with two single questions. Negative attitudes to depression were analyzed in relation to MPA-review and MPA-talk using binary logistic regression analysis with adjustments for sex, education, managerial experience and training, lived experiences of CMD, work organizational context and general preventive actions in the organization towards CMD. 

Results: The proportion of managers with negative attitudes to depression was 20%, performing MPA-review and MPA-talk was 50% and 57% respectively. Adjusted for all co-variates, managers with negative attitudes towards employees with depression were less likely to do both MPA-review (OR 0.71; 95% CI, 0.57-0.89) and MPA-talk (OR 0.53; 95% CI, 0.42-0.66).

Conclusions: Managers with negative attitudes to depression were less likely to take actions to prevent CMD among their employees which confirmed the study hypotheses. The study suggests that initiatives to reduce stigma among managers could be a way forward to prevent CMD at work.

Key messages: • Stigma to depression hampers managers’ prevention of CMD and needs to be addressed. • To increase managers prevention of CMD, managerial training to reduce stigma towards depression is essential.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.

Background: Despite managers’ responsibility for work environment and employee health few studies have investigated managers’ actions to prevent common mental disorders (CMD). Concerning prevention of CMD, qualitative studies report managers feeling unconfident. We investigated managers’ self-confidence in supporting employees with CMD and two managerial preventive actions (MPA): ‘reviewing assignments and the work situation’ (MPA-review) and ‘taking initiative to talk about depression and anxiety at the workplace’ (MPA-talk). We hypothesized that managers’ self-confidence in supporting employees with CMD would be positively associated with both MPAs.

Methods: An on-line survey was sent in 2017 to 4737 managers, answer rate 71% (n = 3358), of which 2 899 were included in this study. Both independent and dependent variables were measured through single questions. Self-confidence in supporting employees with CMD was analyzed in relation to MPA-review and MPA-talk using binary logistic regression analysis adjusted for sex, education, managerial experience and training, lived experiences of CMD, work organizational context and general preventive actions in the organization towards CMD.

Results: The proportion of managers with higher self-confidence in supporting employees with CMD was 48.9%, performing MPA-review and MPA-talk was 50% and 57% respectively. Adjusted for all co-variates, managers with higher self-confidence in supporting employees with CMDs were more likely to do both MPA-review (OR 1.57; 95% CI, 1.31-1.87) and MPA-talk (OR 2.06; 95% CI, 1.71-2.25).

Conclusions: The study hypotheses were confirmed. Managers with more self-confidence in supporting employees with CMD were more likely to take actions to prevent CMD, particularly regarding initiating talks about CMD with subordinates. The study suggests it is important to strengthen managers self-confidence in supporting employees with CMD to increase their preventive actions towards CMD.

Key messages: • Managers’ self-confidence in supporting employees with CMD is vital for workplace prevention. • To strengthen managers’ self-confidence in supporting employees with CMD is essential.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.

Background: To combat discrimination, the Convention on the Rights of Persons with Disabilities mandates equal work opportunities. Individuals with intellectual disabilities engage in work spanning from competitive jobs to vocational activities. Little is known about their occupational patterns, and knowledge about how these evolve over time is lacking. This study aimed to address these gaps, using longitudinal and cross-sectional approaches.

Method: Through record linkage of Swedish population-based registers, data on intellectual disability and occupational status in 2011, 2013, 2015, 2017, and 2020 were obtained. Two cohorts were examined. Cohort 1 (individuals who left Upper Secondary School for pupils with Intellectual Disability (USSID) in 2001–2011, n = 11 704) was used to study changes in different occupational groups (daily activity, work, studies, and unknown) between 2011 and 2020. Cohort 2 (individuals who left USSID in 2001–2020, n = 26 424) was used to describe occupational patterns in 2020.

Findings: By 2020, the proportion of cohort 1 individuals in daily activity was significantly lower compared to 2011. The proportion of working individuals increased each year until 2017. Simultaneously, the proportion of students decreased. The proportion of individuals with an unknown occupation decreased until 2015. Nearly half of the cohort 2 individuals were engaged in daily activity, approximately a third were working, about 4% were studying, and around one-sixth had no known occupation in 2020.

Conclusions: Minor, yet significant, shifts in proportions were evident across all years within all cohort 1 groups compared to baseline. A positive trend emerged with a steadily increasing proportion of working individuals until 2017, suggesting that as time progresses, more individuals seem to enter the workforce. The findings can serve as a foundation for informed decisions in the pursuit of equal opportunities. However, further research is required to understand the underlying factors behind the findings. © 2024 John Wiley & Sons and MENCAP.

Knowledge about the living conditions for people with intellectual disability (ID) is limited, not least since they constitute such a small group, which puts them at risk of being invisible in the general statistics. Thus, there is a great need of a complete register of individuals in this group.

The Swedish Halmstad University Register on Pupils with Intellectual Disability (HURPID) is the first population-based, nationwide sample of former pupils in upper secondary school for pupils with intellectual disability (n = 26 906). The aim of this presentation is to provide a description of that register.

HURPID consists of pupils who were assessed as not having the ability to reach the knowledge requirements of upper secondary school, due to ID, during the academic years of 2000/2001 – 2019/2020. The cohort was established to study the transition from school to working age and to follow the development regarding living conditions, occupational patterns, and health over time. 

School leaving certificates and corresponding documents of former pupils who attended the school form in question during the academic years of 2000/2001 - 2010/2011 were collected in 2011-2012. Information on national identification number, sex, program, municipality, graduation year and complete/incomplete degree were registered. In 2020-2022, a similar data collection was carried out and corresponding information for the academic years of 2011/2012 - 2019/2020 was added (total n = 11 077 women and 15 829 men).

So far, HURPID has been used to study occupational patterns in general (also including exploration of those not involved in employment, education, or daily activity), comorbidity, mortality, heritability, substance abuse, crime, and victimization. Future studies may, for example, examine occupational patterns over time, changes after reforms, need of support, financial situation, access to health care, comparisons with individuals with low intellectual ability (without ID), risk factors for ID and penal sanctions.

Background: Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people'shealth and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. Methods: An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. Results: The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and youngpeople becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. Conclusions: This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted. © 2018 The Author(s).

Objective: To examine early life risk factors for an elevated waist-to-height ratio (WHtR) at 5 years of age. A second aim was to examine if the same risk factors also were associated with overweight or obesity at the same age.

Methods: A population-based longitudinal birth cohort study of 1,540 children, from the southwestern part of Sweden, born between October 2007 and December 2008. The children were classified as having ≥ 1 or < 1 in WHtR standard deviation scores (SDS) at five years of age, according to Swedish reference values and as having overweight/obesity or normal weight/underweight according to the IOTF. 

Results: At five years of age, 15% of the children had WHtR_SDS ³ 1 and 11% had overweight or obesity. In multivariable analyses, RWG during 0-6 months (OR: 1.90, 95% CI: 1.23, 2.95), maternal pre- pregnancy BMI (1.06, 1.01,1.11) and paternal BMI (1.11, 1.01-1.21) were associated with a WHtR_SDS ³ 1 at five years. RWG during 0-6 months (2.53, 1.53, 4,20), during 6-12 months (2.82, 1.37, 5.79) and maternal pre-pregnancy BMI (1.12, 1.06,1.17) was associated with overweight or obesity at 5 years of age.

Conclusions: Risk factors operating early in life are associated with an elevated WHtR and overweight or obesity at 5 years of age. Preventive interventions should especially address early RWG and parental overweight.

Background/Objectives: Obesity-related adverse health consequences are closely associated with abdominal obesity. Risk factors for overweight and obesity have been studied but there is a lack of information regarding risk factors for abdominal obesity, especially in the preschool population. The aim of the present study was to examine early life risk factors for an increased waist-to-height ratio (WHtR) in children at five years of age and, in addition, to investigate if these risk factors also were associated with overweight or obesity. 

Subjects/Methods: The study population comprised 1,540 children from a population-based longitudinal birth cohort study that included 2,666 Swedish children. The children were included if they had complete growth data for the analyses used in this study. Children were classified as having WHtR standard deviation scores (SDS) ≥ 1 or < 1 at five years of age, according to Swedish reference values, and as having body mass index standard deviation scores (BMI_SDS) for overweight/obesity, or normal weight/underweight according to the International Obesity Task Force criteria. Associations between child-related, socioeconomic status-related, parental health-related and nutrition- and feeding practice-related factors during the first two years and a WHtR_SDS ≥ 1 or a BMI_SDS for overweight/obesity at five years were investigated with logistic regression analyses. 

Results: At five years of age, 15% of the children had WHtR_SDS ≥ 1 and 11% had overweight or obesity. In multivariable analyses, rapid weight gain (RWG) during 0-6 months (OR: 1.90, 95% CI: 1.23–2.95, p=0.004), maternal pre-pregnancy BMI (1.06, 1.01–1.11, p=0.019) and paternal BMI (1.11, 1.01–1.21, p=0.028) were associated with WHtR_SDS ≥ 1. RWG during 0-6 months (2.53, 1.53–4.20, p<0.001), 6-12 months (2.82, 1.37–5.79, p=0.005), and maternal pre-pregnancy BMI (1.11, 1.06–1.17, p<0.001) were associated with overweight or obesity.

Conclusions: Early risk factors, including rapid weight gain, are associated with increased WHtRSDS and overweight or obesity at 5 years of age. Preventive interventions should target early RWG and parental overweight and obesity. 

Background: Rapid weight gain (RWG) during infancy increases the risk of excess weight later in life. Nutrition- and feeding practices associated with RWG need to be further examined. The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year of life.

Methods: A population-based longitudinal birth cohort study of 1780 infants, classified as having RWG or non-RWG during 0–3-4, 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related factors and RWG were examined with logistic regression models.

Results: Of the participating infants, 47% had RWG during 0–3-4 months, 46% during 0–6 months and 8% during 6–12 months. In the fully adjusted models, bottle-feeding at birth and at 3–4 months and nighttime meals containing formula milk were positively associated with RWG during 0–3-4 months (p < 0.05 for all). Breastfeeding at 3–4 months and nighttime meals containing breast milk were negatively associated with RWG during this period

(p < 0.001). Bottle-feeding at birth, 3–4 and 6 months and nighttime meals containing formula milk at 3–4 months were positively associated with RWG during 0–6 months (p < 0.01 for all). Breastfeeding at 3–4 and 6 months was negatively associated with RWG (p < 0.01). During 6–12 months, only bottle-feeding at 3–4 months was positively associated with RWG (p < 0.05).

Conclusions: RWG was more common during the first 6 months of life and bottle-feeding and formula milk given at night were risk factors for RWG during this period. © 2020, The Author(s).

Background:  Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age.

Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests and Chi-squared tests were used in the analyses.

Results: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1.

Conclusions: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

© 2018, International Pediatric Research Foundation, Inc.

There is limited knowledge regarding people with intellectual disability and their occupations in Sweden. The aim of the study was to examine young adults with intellectual disability who after secondary school participate in disability day programs (daily activity), with a focus on characteristics and longitudinal analyses of movements between occupations. The study used a national register of 26,908 people with intellectual disability, of which 13,128 individuals (48.8%) participated in daily activity. The group had slightly more men than women, many had attended individual programs in school, and significant associations were found between background factors and participating in daily activity. Proportions in daily activity remained stable over time; however, some individuals transitioned to employment or no known occupation. The study presents national and longitudinal understanding, highlighting the dominance of daily activity as an occupation. Further research is needed to increase knowledge on meaningful occupations for people with intellectual disability. © The Author(s) 2024.

Successful and timely accomplishment of a doctoral education is an important and increasingly addressed issue in PhD programs. Improvement of women’s and men’s education completion rates has been highlighted in an ongoing development of a gender mainstreaming plan in Swedish universities.

During the last decade the organizational demands in academia have however been intensified. Increased expectations on scientific output in terms of publications in international high- ranked scientific journals together with stricter regulations and routines have imposed more work tasks to be handled with a reported stressful and demanding work situation among doctoral students as a result. The informal prevailing culture that meets the doctoral student in academia is also often characterized by long working hours involving expectations of unlimited work time. The research project, process and outcomes are anticipated to be put in first place.

Moreover, the traditional concept of work assumes a separation between work and private life where work is expected to be ranked as the primary commitment. Previous research on work- life balance have showed that the situation in academic work places, i.e. often long work hours and comprehensive work demands in combination with high job commitment and high job autonomy, could have an adverse effect on the individual’s possibility to achieve a balanced work-life situation.

The doctoral education period often collides with the family formation period, including raising children, which makes work- life balance issues even more worth addressing. The proportion of female doctoral students is high in PhD programs in health and life sciences in Sweden as in many other countries. Gender stratification has been reported in relation to responsibility for household and family issues which might influence the ability to achieve a more optimal work-life balance.

Research has foremost been conducted with a pre-view that interference between work and family are gendered and that the two domains are experienced differently by women and men. The aim of this study is to investigate potential conflicts between work and private life that can arise from academic workload and affect work-life balance in female and male doctoral students. A secondary aim is to describe how an (im)balanced situation may influence doctoral students self-perceived well-being and coping strategies.

Introduction: The healthcare sector in many countries, including Sweden, is highly gender segregated with more female than male employees. During the last decades, reports on exacerbating job demands and sickness absence have increased.

Methods: Register data on sickness absence, comprising all female employees in the healthcare sector in Sweden in 2014 (N=210,909) and in 2018 (N=223,715), were analyzed. Logistic regressions yielding odds ratios (OR) with 95% confidence intervals (CI) of new SA (in SA spells >14 days) and of long-term SA (>90 days) due to all cause diagnoses and mental diagnoses respectively, in 2018 compared to 2014, were estimated, adjusting for age, educational level and country of birth.

Results: The risk of new SA and long-term SA due to a mental diagnosis were somewhat higher in 2018, OR 1.14, CI; 1.11 - 1.17 and OR 1.13, CI; 1.08 - 1.18, while no significant associations could be established in relation to SA due to all-cause diagnoses. After adjustments, the results did not change and remained significant.

Discussion: The somewhat higher risk of SA in mental diagnoses over time was not significantly affected by sociodemographic and socioeconomic factors previously shown to influence SA. Psychosocial and emotional work demands together with reports on threats and violence may increase job strain in health workers and influence the risk of SA due to mental diagnoses.

Conclusion: In preventing SA due to mental diagnoses among health workers an effective measure may be to closely monitor various dimensions of work demands.

© The Author(s) 2024

Division of domestic work by gender has been discussed as part of the explanation why women present a higher sickness absence rate than men. This study aimed to examine the association between gender equality in domestic work and sickness absence. Data from 2,609 co-habiting women and men (aged 19–64) collected in a general population in Sweden were used. Associations between different measures of gender equality in domestic work and numbers of sick-leave days were analyzed with logistic regression analysis adjusted for age, children, and paid work. Results show that women reported lower levels of gender equality than men did. Satisfaction with division of domestic work was in the final model associated with lower odds ratio (OR) for sickness absence in men irrespective of number of days. Work-family conflicts were associated with higher ORs for sickness absence in men, 1–7 sick-leave days (OR 1.51 (CI 1.04–2.18)), and in women, 8–30 days (OR 1.51 (1.00–2.33)). More knowledge on the meaning of gender equality in domestic work in relation to sickness absence for women and men are important for future prevention activities. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.

Aim: The objective of this thesis was to analyse the importance of specific exposures in women’s lives to health and sickness absence; more precisely to study the association between domestic work, multiple roles and the experience of being sick-listed, and self-rated health, psychiatric disorders and sickness absence. Method: The thesis was based on two datasets. ‘Women’s health and living conditions’ (WHL) is a cross-sectional study on 1 417 employed women aged 17 to 64 years old. Data was collected with a questionnaire, and register and employee data on sickness absence. ‘Women and alcohol in Göteborg’ (WAG) is a prospective cohort study on 1 799 women in eight age cohorts born from 1925 to 1980. Data was collected with a screening questionnaire, interviews and register-based sickness absence. Several aspects of domestic work, multiple roles and experience of sickness absence were analysed in relation to self-rated health (SF-36), psychiatric disorders (DSM-III and IV) and sickness absence. The study on multiple roles emanated from the role strain and role enhancement hypotheses and roles were analysed as single roles and as combinations of roles. Changes in self-rated physical health were assessed in relation to experience of sickness absence over five year. Cross-sectional and longitudinal analyses were conducted using multivariate regressions analyses. Results: Domestic job strain and a lack of domestic work equity and marital satisfaction were associated with lower self-rated health particularly vitality and mental health. The former was not associated to sickness absence, but the latter was. Women with domestic workload due to children and adults with special needs had higher odds for medium-long sick-leave spells, while parental responsibility gave lower odds for any sick-leave spell. Occupation was related to lower odds for poor self-rated physical health and sickness absence, while the parental role was associated with higher odds for sickness absence. Compared with women who had all three roles women with occupation and partner role had lower odds for negative health outcomes. Support was found for the role strain hypothesis in the cross-sectional analyses of role combinations while neither of the hypotheses was supported in the five year follow up. A lower proportion of those who had experience of being sick-listed reported good health at both baseline and follow up. Women with psychiatric disorders had higher odds for a change from poor to good self-rated physical health over the five years if they had been sick-listed. Conclusion: Domestic workload was associated to health and sickness absence in women, but there were inconsistencies in the findings on children and being a parent and on multiple roles. From a public health perspective, deeper knowledge on the importance of women’s engagement domestic work and its different dimensions is important for promoting women’s health. A multidimensional assessment of domestic work is important and the content and complexity of domestic work and of different roles needs to be further explored in relation to health and sickness absence in women.